Premature infants who were delivered by cesarean section and underwent umbilical cord milking had greater systemic blood flow, hemoglobin levels, and urine output than those who received a delayed cord clamping.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Current recommendations endorse a delay in umbilical cord clamping (DCC) for all preterm infant deliveries. Previous research has shown benefits to umbilical cord milking (UCM) but, to this date, there have not been any trials comparing UCM and DCC. Authors of the current study sought to determine whether preterm infants after a cesarean delivery who underwent UCM had greater systemic blood flow than those who underwent DCC. Results indicated that preterm infants who were born by cesarean delivery and received UCM displayed evidence of higher systemic blood flow, hemoglobin levels, and urine output in the first 24 hours of life. No significant differences were found between UCM and DCC in the vaginal delivery group. This study may be limited by the small number of infants born before 29 weeks gestation and no immediate cord clamping group for comparison. Nonetheless, these findings may encourage obstetricians to consider umbilical cord milking after premature cesarean deliveries.
In-Depth [randomized controlled trial]: A total of 197 infants (vaginal delivery, n=43; cesarean delivery, n=154) were included for analysis in this study; all infants were randomized to receive UCM or DCC. Participants were recruited from the Sharp Mary Birch Hospital and Loma Linda University Medical Center. Infants were 23 to 31 6/7 weeks gestation. Participants received an echocardiogram, continuous hemodynamic recordings, hematocrit blood draw, and a head ultrasound to document any evidence of intraventricular hemorrhage. Superior vena cava flow, right/left ventricular output, and diameter and direction of flow through the patent ductus arteriosus and foramen ovale were obtained with electrical cardiometry. In the cesarean delivery groups, infants who were randomized to the UCM treatment had higher levels of superior vena cava flow (p < .05) and right ventricular output (p < .001) in the first 12 hours of life. The UCM group had higher hemoglobin levels (p < .05) and blood pressures (p <.05) in the first 15 hours of life, as well as higher amounts of urine output (p < .05) in the first 24 hours. No significant differences among preterm infant parameters were noted between the UCM and DCC groups in the vaginal delivery cohort.
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